This guide provides guidance to assist licensing agencies in making decisions about an individuals fitness for driving. This is the first attempt to produce a consolidated document covering medical conditions included in the task agreement between the National Highway Traffic Safety Administration (NHTSA) and the American Association of Motor Vehicle Administrators (AAMVA). Many medical conditions are not covered by this document. They have been excluded in order to limit the project to manageable objectives and to focus on the most common conditions. Additional conditions will be addressed in subsequent projects. Evaluations of driver fitness should not be limited to only those medical conditions that are addressed in this guide. A broadspectrum approach is best when addressing driver fitness. Individual evaluations should assess vision, physical impairments, and medical conditions such as diabetes, dementia, sleep apnea, and seizures. Temporary medical conditions should also be assessed. These guidelines are voluntary. They are provided to assist motor vehicle administrations in making the difficult decisions that weigh an individuals driving privilege against the demands of public safety. Establishing medical guidelines that are applicable for all jurisdictions has been challenging. This guide was not created to determine the methods by which jurisdictions should make these decisions. Whether to use medical advisory boards, administrative review, or a combination of these should be determined within each jurisdiction. Although these guidelines are based upon a scientific literature review and provide general recommendations, decisions concerning a driver's ability should be made on a case-by-case basis.